Leak Adjustment Form PDF Details

Unexpected leaks can lead to surprisingly high water bills, leaving property owners facing expenses far beyond the ordinary. In response, the City of Houston offers a compassionate solution through its Leak Adjustment Request Form, a crucial document for residents grappling with the financial implications of water loss due to excusable defects. Such defects are recognized as ruptures or leakages caused by forces beyond the control of a property owner, including adverse weather conditions, natural settlement, corrosion, wear and tear, or accidental damage. However, it's important to note that not all leaks qualify; visible leaks that are considered preventable, such as those from faucets or hoses, do not meet the criteria for adjustment. The form outlines a process where affected customers can seek relief for a portion of their inflated bills—specifically, a credit for one-half of the rate charged for usage exceeding the average, limited to a span of three consecutive months and contingent upon application within six months post-repair. Additionally, the ordinance caps the number of adjustments a customer can request within a year, enforcing a limit to ensure fairness. The document further details the necessary steps to validate the claim, including the provision of repair documentation, and sets expectations regarding the timeline for city response. While the prospect of navigating this process may seem daunting, understanding the Leak Adjustment Request Form is a valuable first step towards mitigating the financial burden of uncontrollable water loss.

QuestionAnswer
Form NameLeak Adjustment Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesleak adjustment request form, texas leak adjustment form, city of houston water, city of houston water leak

Form Preview Example

CITY OF HOUSTON

Public Works and Engineering

Department

Leak Adjustment Request Form

Account No. _____________________________________

Utility Customer Service P.O. Box 4863

Houston, Texas 77210-4863 www.houstontx.gov

Service Address __________________________________

Daytime Phone No. __________________________

A City of Houston ordinance allows for a Leak Adjustment credit because of loss of water through an “excusable defect” in the customer’s water line. An excusable defect is due to a rupture or leakage caused by weather, settlement, corrosion, wear, or accident. Visible leaks such as faucet and hose leaks are ineligible. Credit may be given for one-half of the rate charged to usage in excess of the average. This adjustment is limited to a maximum of three (3) consecutive months and must be requested within six (6) months of the repair. Customers may apply for no more than two (2) leak adjustments in any twelve (12) month period.

I, _____________________________________, am the Responsible Party for the account at the above service address.

(Give full legal name and/or business identity)

I am asking the City of Houston to reduce the water bills for this account, to the extent allowed by city ordinance because of a leak beginning on (date) ______________ and repaired on (date) _______________. During this period, the following

additional water appliances (washer, dishwasher, spa, etc.) were installed at the service address. State “NONE” if none were added: ______________________________________. The water lost from this leak was not used by anyone.

IN ORDER TO PROCESS YOUR APPLICATION QUICKLY & EFFICIENTLY, PLEASE READ THE FOLLOWING CAREFULLY AND GIVE A COMPLETE AND CLEAR DESCRIPTION OF THE REPAIRS.

Type of leak on customer’s side of meter: _______________________________________________________________

Description of repair:________________________________________________________________________________

________________________________________________________________________________________________

Attach documentation of the repair date, address, type of repair, and cost. Acceptable documents include plumber’s statement/bill or a receipt for parts. Businesses with in-house maintenance may submit a statement signed by two (2) employees who witnessed the repair.

In all cases the City retains the right to make field verifications before approving leak adjustments. You will be notified by mail generally within 90 days whether your request is approved or denied.

I am familiar with all of the facts stated in this document and they are true and correct. Making false statements on this government record is subject to criminal prosecution under Chapter 37 of the Texas Penal Code. I certify that this application and attached documents contain no false statements.

Print Name: _____________________________________________________ Date: _______________________

Signature of person requesting a leak adjustment: _______________________________________________________

Complete the form and return to Utility Customer Service, Accounting Section, P.O. Box 4863, Houston, Texas 77210-4863. Please call our Customer Service Center at 713-371-1400, if you have any questions.

Leak Adjustment Req Form ENG - 2-09-10.DOC

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